What is an ICL?  These are exciting devices to help correct very severe degrees of near-sightedness, farsightedness and astigmatism.  They are a thin piece of soft plastic, much like a contact lens.  But, unlike a contact lens, it can be inserted actually into the eye, and remains there.  It has the lens correction built into it and never needs to be removed or cleaned.  I have patients who are blind without glasses or contacts and now can see near 20/20 (normal)  Imagine not being able to see anything clearly past the tip of your nose, and then leaving after a 20 minute operation and being able to see across the street.  It is really quite amazing.  The ICL is also for people with thin corneas that may not be eligible for laser vision correction.

At our centre, we have decided to concentrate on IntraLase for preparing the flap, and VisX CustomVue for the corneal shaping.  Why?  because there are now several good studies that show that this is the winning combination to give people the best results, closest to target, in the safest way possible.  So we don’t want to offer anything else, even though decent results can be obtained with other methods.  To us, decent is not good enough.  IntraLase/CustomVue is giving us outstanding results, which is what it is all about.  So we think we are offering tremendous value to our patients.  High likelihood of no glasses, with the lowest chance of having a flap problem.  In comparison, I once had to take my dog to the vet for an operation, and the bill was $2000.  When I looked it over, it was totally reasonable. The doctor has a business to run, and has expenses we don’t even imagine.  So too in the Laser vision correction area, there are expensive devices, insurance, staffing etc, that actually makes $2500 per eye  sound like a very good value for a life changing experience.

We offer CustomVue, wavefront guided treatment to almost all our patients.  The standard treatments, while good, represent older, less precise ways of reshaping the cornea.  Without CustomVue, we cannot utilize the iris registration program, which allows us to precisely align the laser treatment and uniquely identify our patients by the laser.  This alignment ensures a great result and takes into acount the shifting of the pupil when the pupil gets smaller.  I can tell you, the smoothness of the surface after the laser is applied, is truly remarkable.  While our older laser was good, the VisX Star S4 with iris registration is a quantum leap forward, so much so that we recommend it in most instances.

No, not at all.  After the first day of using the IntraLase, I decided not to offer the treatment to patients.  I felt the microkeratome, while  a good device, has had its time in the sun, and it was appropriate to move on to better methods of creating the flap.  And now there is lots of information and data out there to support the better outcomes that are available combining IntraLase with CustomVue (VisX) laser treatment.  When I had my PRK and my wife had her LASIK (9 years ago),  the IntraLase and CustomVue were not available, but if they were, we would have had it done that method.

Yes, sometimes they do.  Most often on the day of surgery, less than 2% of the time.  When this happens we will float the flap back into place and that takes care of the problem.  In terms of late dislocations, this happens rarely.  We have had 3 patients in the past 10 years that have had direct blows to the eye that have moved the flap.  They were repaired promptly and all recovered excellent vision.  Interestingly, we have not had a single flap dislocated since we switched to IntraLase, I think due to the stronger healing that occurs with the IntraLase. 

People ask me:  ”Why did you go this route, using the Intralase for the first step, flap creation in LASIK?  Is it really necessary, I’ve heard that the blade technique has been around a long time”.  At first I also thought that  the microkeratome (blade) is so safe, complications so rare, it is worth the half a million dollars that it cost, plus the continued upkeep in order to switch to IntraLase?  Well, I can honestly say, yes it is worth it.  To my patients, it gives them the assurance they are getting the safest and best possible flap on their cornea.  For me, it makes the surgery more exciting and relaxing at the same time.  It is thrilling to watch the laser form millions of microscopic bubbles in the cornea so close together that a flap is created.  Within 30 seconds, a perfect smooth layer has been made.  We measure the flap thickness each time and it so close to what we predict, it is almost uncanny.  That vertical edge on the flap, makes it like a man-hole cover on the street.  In other words, it flips back into position and seals very securely.  It is more relaxing, because there is not that moment where we hold our breath, as we did with the microkeratome, as the blade passes across the eye.

 Getting back to the IntraLase, it is used for making the LASIK flap, but it doesn’t stop there.  The company behind this machine has now made it possible to use the laser for therapeutic applications.  This means that my patients with cornea problems that are fixable with a corneal transplant can now be operated on with a laser.  The cornea is a very thin curved tissue on the front of the eye.  It functions like a lens, and that is why we can reshape it with the laser and correct for the need to wear glasses.   But, there are many unfortunate people out there with problems with the cornea that cannot be corrected with the laser.  For these patients, a corneal transplant may correct their problem by putting a new clear window in place.  This is great, but has its down side too.  The healing is prolonged, and often there is much astigmatism after.  This is where the IntraLase comes in and can help.  The laser is so precise, that it can cut a perfect circle, give us alignment marks and even shape the edge, much as a carpenter does to shape a tongue-in-grove joint.   This makes the cornea heal better and quicker.  Truly science fiction.  And we at Yonge Eglinton Laser Eye Centre, are the first in Canada, in fact one of the few places in the world to be able to offer this type of transplant.  It is very exciting to be part of this revolution and can’t wait to see the further developments.

 Are these for everyone?  Not really.  Though they were developed first for the correction of near-sightedness, they didn’t pan out for this group of patients.  However, a doctor in France suspected they might be good for patients with a condition called keratoconus.  You will remember that the cornea is the clear dome on the front of the eye and functions as the major lens of the eye. This allows us to use our lasers to correct near-sightedness, farsightedness and astigmatism.  If you have keratoconus, your cornea is distorted, and vision is blurry.  This is often correctable with hard contact lenses, but often, the lenses are uncomfortable and don’t correct the vision all that well.  That is where Intacs can help.  Intacs are small, clear half ring segments that are imbedded in the cornea; they reshape the cornea, and generally improve the quality of vision and make it possible for many patients to see with glasses or contact lenses.  Unfortunately, they don’t work in all patients with Keratoconus, but they do help in many, many people with this condition.We make a special little channel in the cornea using the IntraLase.  (You are probably starting to notice that we use the IntraLase for many different purposes, it is true, we do!)  At any rate, we then can insert these little ring segments (Intacs) into the channels.  The procedure is painless, done with numbing the eye with drops only.  It takes about 20 minutes, and most people are feeling fine by the next day.  The first night there is some scratchy discomfort, but this quickly passes.  Most people with Keratoconus notice some immediate improvement in quality of vision, but it can take up to 6 months to fully stabilize.  They don’t always work though, and in some people they can be uncomfortable.  The good news is, that if they don’t work, they can be removed.   These Intac implants are a good alternative.  Until recently, all we had was a corneal transplant for patients with keratoconus.  Now we can treat some people and avoid a more major surgery, though when needed, a transplant is a very good operation for patients with keratoconus, with an excellent outcome and long track record.  We have been doing corneal transplants for more than 50 years, and thousands of people world wide undergo this sight restoring operation for many different conditions.

Lots!  We received the IntraLase laser now 2 years ago, and it has been a fantastic experience for our patients and our staff too.  It makes the whole process of creating the flap for LASIK so much more comfortable.  It is amazing to watch the mini bubbles forming in the cornea.  Each one so close together to the next, that a perfect flap is formed.   We recently upgraded to the FS 60 model, and this means an even faster and smoother flap formation, more than cutting the time in half, so now we can make the flap in less than half a minute.  Super speed and safety.  We use this speed to make the laser spots even closer together, which translates into an even smoother flap surface.We also have a new laser to add to our lineup.  We bought a VisX Star S4 laser with iris recognition.   Why the switch, when we were getting excellent results and happy patients with our previous excimer laser?  The easiest way to explain it is, the difference between flying a 747 and an F-16 fighter plane.  The 747 is a sophisticated plane with all the fancy controls, but an F-16 incorporates all the latest navigation and control electronics.   For instance, on the VisX Star S4, we have a system of Iris Recognition.  What is that?  Iris recognition is a great system.  When your eye is measured with our Wavescan to take a picture of your unique eye, it also photographs your iris with infrared light.  This photo is like the biometric photos that are being used more commonly for security purposes, this picture is used to uniquely identify your eye and the laser is then aligned using the pattern of the colored part of your eye, the iris.   I looked around at all the available lasers and was convinced that the VisX system was the best on the market, and our experiences have verified that we made the right choice!

What other features does this laser have?  It also centers the laser treatment on the centre of your pupil, the dark central part of the eye.  This is important, because the centre of the pupil can shift when the pupil gets small, for instance, when the light shone in the eye is bright.  The laser knows this, and makes a compensating movement.  This ensures that the laser treatment is applied exactly where it should be.

 Customvue is the laser system used on the VisX laser.  All lasers out there treat the major imperfections of the eye, the ones we commonly call nearsightedness, farsightedness and astigmatism.  Yet there are other irregularities that we notice most in the dark, when the pupil is very large.  The best example of this is driving at night.  That is when people notice that headlights of oncoming cars are not distinct, small points of light. This is because at night, our pupils enlarge, and the edge of our lens and cornea contribute more to the images we see.  It is the edges that make lights seem to flare and spread.  The VisX system measures these imperfections; we call them higher order aberrations.   The laser then programs the treatment to correct not only your nearsightedness, but also these higher order aberrations.  Why is this important?  It lessens the chance of having glare and star bursting at night by correcting the aberrations and thus images are more sharply focused on our retina, the seeing part of our eye.

Getting back to the IntraLase, it is used for making the LASIK flap, but it doesn’t stop there.  The company behind this machine has now made it possible to use the laser for therapeutic applications.  This means that my patients with cornea problems that are fixable with a corneal transplant can now be operated on with a laser.  The cornea is a very thin curved tissue on the front of the eye.  It functions like a lens, and that is why we can reshape it with the laser and correct for the need to wear glasses.   But, there are many unfortunate people out there with problems with the cornea that cannot be corrected with the laser.  For these patients, a corneal transplant may correct their problem by putting a new clear window in place.  This is great, but has its down side too.  The healing is prolonged, and often there is much astigmatism after.  This is where the IntraLase comes in and can help.  The laser is so precise, that it can cut a perfect circle, give us alignment marks and even shape the edge, much as a carpenter does to shape a tongue-in-grove joint.   This makes the cornea heal better and quicker.  Truly science fiction.  And we at Yonge Eglinton Laser Eye Centre, are the first in Canada, in fact one of the few places in the world to be able to offer this type of transplant.  It is very exciting to be part of this revolution and can’t wait to see the further developments.